VERIFICATION OF DEATH

• Assess patient’s condition against following criteria:
• no heart beat heard over 5 min
• no carotid pulse felt over 5 min
• no breath sounds heard and no chest movement seen over 5 min
• pupils fixed and dilated
• corneal reflex absent

Information to be recorded in patient’s medical notes

• Date and time of examination of body
• Entry stating that:
• no heart beat heard over 5 minutes
• no carotid pulse felt over 5 minutes
• no breath sounds heard and no chest movement seen over 5 minutes
• pupils fixed and dilated
• corneal reflex absent
• Patient verified as dead
• Signature, name and designation of verifier

Issuing death certificate

• A doctor who has attended a deceased person during his/her last illness is required to issue a medical certificate stating cause of death ‘to the best of his/her knowledge and belief’
• To issue a certificate, doctor is not obliged to view the body
• good practice requires that, if they have any doubt about fact of death, they should satisfy himself/herself by viewing the body
• As the doctor is not obliged in law to see the body in order to issue a certificate, appropriately trained nurses may expand their role into verification of expected death

Death in hospital

• It is the hospital doctor’s responsibility to:
• inform the Coroner where necessary
• issue death certificate
• inform deceased’s GP

• When registering the death at the registration office, ask whether Coroner must be informed
• the registrar is regularly updated with Coroner’s requirements
• Discuss with the Coroner any case where there is doubt

Old age

• If no specific medical cause of death in a person aged ≥80 yr, report old age as it is an acceptable cause
• best to include co-morbidities in part 2

Inform Coroner if:

Unknown cause

• Cause of death is unknown

? Natural causes

• It cannot readily be certified that death is due to natural causes

No medical attendance

• Not attended by a doctor during their last illness
• Not seen by a doctor within the last 14 days

Suspicious/violent

• Suspicious circumstances or a history of violence

Accident

• Death due to some form of accident
• e.g. fall, road traffic collision, incident at work or in the home
• consider whether an old injury may have caused/contributed to death years later

Self-neglect/neglect by others

• Any suggestion of self-neglect/neglect by others
• including lack of medical care e.g. bed sores not properly treated
• level 1 or 2 bed sores do not need reporting unless other reasons for doing so

Prison/police custody

• Death occurred during/shortly after release from prison, young offenders’ institution or police custody
• even if cause of death due to natural causes

Mental Health Act 1983

• Deceased detained under the Mental Health Act
• no requirement to report deaths of persons who were subject of a DoLS

Abortion

• Maternal deaths
• Infant deaths where infant has drawn breath
• even if abortion legally performed under the Abortion Act
• stillbirths do not need to be reported if doctor satisfied that infant has not drawn breath

Self-harm

• Death may have been due to the actions of the deceased
• e.g. overdose, solvent abuse, alcohol related deaths, self-injury

Industrial disease

• Give details if the deceased had industrial/disability/war pensions
• pneumoconiosis/pulmonary fibrosis (including Farmer’s Lung)/mesothelioma/asbestosis
• only if a history of coal mining, report COPD
• give details of any known employment and smoking history
• pensions for white finger and hearing loss do not qualify under this section

Recent operations/procedures/medicines

• Deaths suspected to be due to/exacerbated by medical intervention/medicines e.g.
• GI bleeds due to warfarin, aspirin, NSAIDs
• pseudomembranous colitis due to antibiotics
• attributable to chemotherapy, immunosuppressive drugs, steroids
• Surgery under general anaesthesia within 12 months of death
• report surgery more than 12 months ago if it has led to the death
• do not report minor surgical procedures (e.g. gastroscopies, endoscopies, biopsies, cataracts etc.) unless complications arose from procedure
• Any death where there is an allegation of medical mismanagement

Admission within 24 hr

• Death occurs within 24 hr of admission to hospital except admission for terminal care

Falls, fractures

• Any fractured limbs within 12 months of death
• do not report falls without serious injury which did not contribute to death

Cerebral haemorrhage, CVA, CVD

• Unless satisfied that haemorrhage entirely non-traumatic e.g. CVA, CVD, report cerebral, subdural or extradural haemorrhage
• Report if a bleed due to/exacerbated by drugs e.g. warfarin, heparin

Cancer related deaths

• Bladder cancer in a person born before 1935 especially if any suggested link with Michelin or where dye works may be implicated
• Carcinomatosis with unknown primary
• Neutropenic sepsis due to chemotherapy

Non-specific Causes

• Report if unable to qualify (be more specific) terms such as:
• cardiac arrest, brain hypoxia
• organ failure, Congestive cardiac failure
• obstruction (e.g. bowel)
• bronchopneumonia, sepsis and peritonitis

Unusual or disturbing features

• Report the features